July 8, 2020 • 40 mins
The Flexner Report in the early 20th century is often credited with changing the medical field and shaping what medical education looks like today. But this document negatively impacted medicine in the black community.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Holly Frying, and I'm Tracy P. Wilson. Uh, Tracy.
One of the topics that's come up a couple of
times for me in recent weeks as I've just been
doing my own reading related to racial injustice is the
(00:24):
Flexner Report. And this was a report that was issued
in the early twentieth century. It is often credited with
changing the medical field and shaping what medical education looks today.
I also found one article that said it's the most
overrated document in medical history, which made me laugh a
bit um. But there are also aspects of this document
that really need to be discussed in terms of how
(00:45):
they impacted the black community. So we're going to talk
about this one in three parts. First, we're going to
talk about Abraham Flexner, for whom the report is named
and who made the report. And then we're going to
talk about the general impact of the Flexner Report on medicine.
And finally we will talk about how this affected black
medical schools specifically. And it is a lot to unpack,
(01:05):
and I hope we managed to do it justice as
with anything related to any of these topics, a person's biography,
the history of any given field, and the history of
how things impact racial injustice. Like, there are always more
nuances than we could ever pack into an episode, but
we're hoping we hit all of the prominent and impertinent points. Yeah,
(01:25):
if you listen to the podcast Saw Bones, they did
an episode which I guess at this point will be
a few weeks ago that was about racism in medicine
and it it alludes to this without going into much
detail about it. So if you if you listen to
our show and that show, these are sort of they'll
complement one another. They do, they do. We didn't plan that,
(01:47):
it just happened. Uh So this starts with Abraham Flexner
and Abraham Flexner was born in Louisville, Kentucky, on November
eighteen sixty six. His father more It's Flexner and his
mother as their Abraham, were German Jewish immigrants. More It's
had a hat business and Esther worked as a seamstress.
(02:08):
The Flexner family was large. Abraham was their sixth child
and they ultimately had nine. Moret's and Esther were able
to build up their finances with The plan not that
they would live lavishly, but that every one of their
sons and there were seven of them, would attend college.
But that plan fell apart when the eighteen seventy three
panic hit and they lost their savings. But Abraham did
(02:31):
manage to go to college. He attended Johns Hopkins University,
and the funds came from his brother, Jacob. The span
and the ages of the Flexner children meant that Jacob
was already established by the time Abraham graduated from high school,
and the money he was making as a drug store
owner was put towards Abraham's tuition. Yeah, they definitely always
(02:52):
prioritized education is where they put their money. Abraham earned
his b a In eighteen eighty six, and his hope
had been and to go into a post graduate program,
but there was not enough money for that, and though
he did try to secure a fellowship and non materialized,
so he went home to Louisville to start his career.
For the next four years, Flexner worked as a high
(03:14):
school teacher, heading up the Latin and Greek classes at
Louisville High School. But during that time he was developing
another idea because he thought there was a better way
to structure education, and that idea manifested as an experimental school,
and Flexner founded that school in eighteen nine. That school
was simply called Mr. Flexner School, and it was incredibly progressive.
(03:35):
The structure probably seemed like no structure at all to
traditional educators. Flexner did away with the idea of a
set curriculum. Students did not have exams, and they did
not receive grades. The vision that Flexner had for this
school was custom tailored education to prepare students for higher learning,
and a lot of his students got into very good schools,
(03:56):
so this was a very successful model. The Flexner family
continued to value education and help one another in that regard.
One of the personal benefits for Abraham Flexner in creating
his school was that he could enroll his brother Simon
there and get him into JOHNS. Hopkins. He was also
able to pay for Simon's tuition. Abraham also helped his
(04:17):
sister Mary, he paid her way at Brent mar This
marks an expansion of the family's plan to not only
educate the men of the family, but also the women,
and education for women was something that Abraham supported throughout
his life. One of the former pupils in Flexner's preparatory school.
A young woman named Anne Crawford also became an important
(04:37):
part of Abraham's life after graduating and had become a teacher.
She had attended Massar in which he finished those studies.
She started working there at the school, and she also
had started to pursue a career as a playwright. Abraham
and Anne fell in love and they were married in
and they eventually had two daughters, Jean and Eleanor. In
nineteen o four, and adapted the novel Mrs Wiggs of
(05:00):
the Cabbage Patch, which is a comedic story about an
impoverished Southern family, into a Broadway play. Mrs Wiggs ran
from September three, nineteen o four, through January nineteen o
five at the Savoy Theater, and it was a success.
The income from Ant's work on the show made it
possible for Abraham to enroll at Harvard to get his
master's degree in psychology. He closed his school to do that.
(05:24):
He also spent a year in Germany as part of
his studies, again bankrolled through his wife's success in the theater.
That time spent in Germany made Flexner deeply aware of
what he saw as the failings of the education system
back home, and as a result, in nineteen o eight,
he researched and wrote an assessment of higher education in
the United States titled the American College a Criticism. Based
(05:48):
on his work examining colleges and identifying what he saw
as the problems at the single school level as well
as systematically, flexnerra was commissioned by the Carnegie Foundation for
an new project. He was asked by the president of
the Carnegie Foundation for the Advancement of Teaching, that was
Henry Smith Pritchett, to apply that same critical and analytical
(06:10):
eye to the medical institutions, specifically in the United States
and Canada. There were a hundred and fifty five medical
schools in his survey. Yeah, he took two years to
basically travel around and visit all these schools and do
his assessment, and then in nt Flexner completed his report
which was titled Medical Education in the United States and Canada.
(06:32):
And when this report came out, it had a massive
impact on medical education in North America. A lot of
the schools that Flexner had found lacking closed as a
consequence of its publication. Others were completely overhauled and essentially
rebuilt from the ground up, and we're going to talk
more about all of that in just a moment. Following
the medical school report, Flexner produced a report at the
(06:54):
behest of the Rockefeller Foundation examining the sex work field
in Europe and how it was re elated. It was
the first of many varied reports that Flexner would compile
for the Foundation. But though he had moved on to
other projects like that, Flexner did not just drop his
medical report and then move on with his life. He
actually dedicated himself to improving medical education, specifically, in nineteen thirteen,
(07:19):
following his report on European sex work, Flexner became the
secretary to the Rockefeller Foundation's General Education Board. During this time,
in his role, he worked on a number of other
research and reporting projects, as we mentioned, but he also
made sure that money from private donors was allocated to
medical education and improving some of the problems he had
(07:40):
discovered while working on his nineteen ten report. In ninety one,
Abraham Flexner wrote a memo for the Rockefeller Foundation's Board
which was titled The Usefulness of Useless Knowledge, and this
memo evolved and it became a lecture, and then, eighteen
years after he initially wrote it, it was published in
Harper's Magazine, And that piece of writing opens with the
(08:01):
following paragraph quote, Is it not a curious fact that,
in a world steeped in irrational hatreds which threatened civilization itself,
men and women, old and young, detached themselves wholly or
partly from the angry current of daily life, to devote
themselves to the cultivation of beauty, to the extension of knowledge,
(08:22):
to the cure of disease, to the amelioration of suffering,
just as though fanatics were not simultaneously engaged in spreading pain, ugliness,
and suffering. The world has always been a sorry and
confused sort of place. Yet poets and artists and scientists
have ignored the factors that would, if attended, to paralyze them.
(08:43):
From a practical point of view, intellectual and spiritual life is,
on the surface, a useless form of activity in which
men indulge because they procure for themselves greater satisfactions than
are otherwise obtainable. In this paper, I shall concern myself
with the question of the extent to which the pursuit
of these useless satisfactions proves unexpectedly the source from which
(09:05):
undreamed of utility is derived. One of the things that
Flexner touches on in this writing is the unintentional outcomes
of pursuits that were of pure intent. He specifically mentions
how the advancement of the cruelty of warfare was fueled
by scientists who were often working they thought for the
betterment of mankind. As the nineteen twenties were on, Abraham
(09:28):
Flexner found himself at odds with other members of the
education board at the Rockefeller Foundation, and this led to
him ultimately being pushed out of the organization in ninety eight.
In nine nine, Abraham Flexner was approached by philanthropist siblings
Lewis and Caroline Bamburger. The Bamburgers thought they could use
their wealth to establish a new medical school in Newark,
(09:51):
New Jersey, and they wanted Flexner as an advisor on
the project. But Flexner pointed out that Newark had neither
a teaching hospital nor a top notch university, both of
which were vital to the success of a medical school,
and Abraham Flexner was really thinking of a different sort
of project, and he was able to convince the Bamburgers
that they should instead invest in his idea, and they
(10:13):
did with a gift of five million dollars. Flexner envisioned
what he would later call an educational utopia that offered
the greatest minds a place where they could be driven
entirely by their curiosity, and so in nineteen thirty Flexner
founded the Institute for Advanced Study in Princeton, New Jersey,
and served as director there until nineteen thirty nine. It's
(10:35):
missions stated quote, the Institute is pledged to assemble a
group of scientists and scholars who, with their pupils and assistants,
may devote themselves to the task of pushing beyond the
present limits of human knowledge, and to training those who
may carry on. In this sense, Flexner was able to
attract some of the biggest names to his institute, including
Albert Einstein, who joined in nineteen thirty three. In the
(10:59):
years since it's founding, the Institute has had as members
or as faculty thirty four Nobel Laureates, forty two Fields Medalists,
and eighteen Abel Prize Laureates. In addition to Einstein, notable
names on that list include Robert Oppenheimer and previous podcast
subject John von Neumann. We're going to cover the end
of Flexner's life and the impact of his work on
(11:20):
medical education, but we're due for a quick break to
have a word from our sponsors. The same year that
he opened his institute, Abraham also published another book about education.
This time it was a comparative review of how schools
(11:41):
ran in different countries, titled Universities American, English, German. Flexner
retired as director at the institute in nineteen thirty nine
after an internal conflict in which the school was accused
of allowing an anti Semitic climate at Princeton, a school
that they routinely worked with. They were allowing that climate
to hinder the work of a lot of the professors.
(12:04):
As tensions among the scholars and leadership war on. Flexner
retired in the autumn of ninety nine. Although he was
in his seventies, He stayed very busy after leaving the institute,
consulting on various projects and writing several books, including his autobiography.
During and after World War Two, several of Abraham's siblings
died by the end of the nineteen forties. Only Abraham
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and his sister Gertrude were still living out of the
nine Flexner siblings. At the same time, his wife, Anne
had gradually developed vascular dementia in nine and had declined
so seriously that she was taken to a Rhode Island sanitarium.
Their two daughters frequently visited her, and they updated their father,
but Abraham never saw Anne again. He had not coped
(12:49):
with her illness well and could not bear to have
the person that he had been so close to no
longer recognize him. He later told friends that he had
actually had a breakdown during this time. As he recovered
from this significant change in his life, Flexner moved to
a hotel near Central Park and enrolled in classes at Columbia.
He opted for classes in literature and history. In nineteen
(13:11):
fifty one, the New York Times read an article about
the eighty five year old Flexner educational reformer taking classes
alongside co Ed's, a quarter his age, and died shortly
before Abraham's ninetieth birthday, which once again sent him into
a dark period, and as he was slowly returning to
his old self, his daughter Jeane convinced him to leave
New York and moved to Falls Church, Virginia, which is
(13:33):
where she lived so that he could be near her,
and he spent two years there and doing a very
active social life and visiting the museums of nearby Washington,
d c. Regularly before his death on September twenty one,
nineteen fifty nine. So moving on to his report about
medical schools. As we mentioned, Flexner covered a hundred and
fifty five schools in his nineteen ten report, and in
(13:55):
researching that report, he had visited each school and written
detailed and comprehensive notes about their entrance requirements, faculty funding, laboratories,
and connections with affiliated hospitals. In the five decades before
his research, massive advances in science and medicine had been made,
but because there was no comprehensive guidance for how medical
(14:16):
schools operated, a lot of them were still teaching out
of date information, basically telling future doctors stuff that wasn't
believed to be true anymore. This was in large part
because the faculty at many medical schools consisted largely of
practicing physicians who were teaching exactly as they had been
taught without updating that information with the changing times. Bacteriology,
(14:40):
diagnostic developments, and surgical techniques were all rapidly changing fields,
and if a school wasn't keeping up the doctors they trained,
or in danger of offering their patients poor or outdated
care at best and endangering their lives at worst. To
compound that problem, there were a lot of new medical
schools opening with totally read standards for entry. When Flexner
(15:03):
published to study, seventy four percent of a medical schools
that were open required only a high school education for admission.
Some were willing to accept high school equivalency certificates, which
meant that there was really no clear standard. Only a
fifth of the schools required two or more years of
college prior to entry. Many were essentially profit driven businesses.
(15:26):
Abraham Flexner was also very frank in his report about
how little the public really knew about the workings of
any given medical school. He wrote in the introduction quote,
educational institutions, particularly those which are connected with a college
or a university, are peculiarly sensitive to outside criticism, and
particularly to any statement of the circumstances of their own
(15:48):
conduct or equipment which seems to them unfavorable in comparison
with that of other institutions. As a rule, the only
knowledge which the public has concerning an institution of learning
is derived from the statements given out by the institution itself,
information which, even under the best circumstances, is colored by
local hopes, ambitions, and points of view. Flexner felt that
(16:12):
this work was vital and important to be doing, writing
that the information in it was of importance not just
to medical practitioners, but to quote every citizen of the
United States and Canada. Abraham Flexner, building on standards that
were already in place in Germany, established standards of evaluation
for the medical schools and his study and then judged
(16:32):
each one against those criteria. And we should note that
he was not the first person to do this. In
the United States, the Association of American Medical Colleges, founded
in eighteen seventy six and consisting of twenty two member schools,
had agreed on curriculum standards to provide uniformity in medical
education that had happened after an assessment of the state
(16:52):
of medical education. The a a m C continued to
grow and reevaluate in the years between its founding and
flex Nurse Report. The American Medical Association had similarly started
issuing reports on the status of medical education as early
as eight and some of the criteria they used were
present in Flexner's evaluation system as well, but neither of
(17:15):
these had oversight over all medical schools. It was an
opt in on a set of standards. All of Flexner's
work was aimed at determining, in his opinion, whether a
school was able to effectively teach its students modern medicine.
The model that he drew up for what this looked
like included admittance requirements of college level biology, chemistry, and
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physics courses, a curriculum with both lecture and lab teaching
of anatomy, pathology, bacteriology, and pharmacology, among other courses, access
to teaching hospitals for hands on experience, salaried faculty who
were exclusively working in teaching and research, not practicing doctors
who just taught on the side. Flexner laid out his
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finding state by state and school by school. He was
detailed calling out if he had found dirty labs or
lacks standards. He criticized the way the days were scheduled
at schools and how exhausted students were often sitting through
hours of dull lectures by part time faculty. Because he
was an outsider, an education reformer rather than a member
(18:20):
of the medical community. His assessment was without preconception and
it was brutally honest, offering the general public a startling
look at the way people who cared for their health
were being educated. Flexner advocated for state licensing boards to
take a more assertive role in modernizing medicine by refusing
to license graduates from schools that were not up to standards,
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and he believed that a lot of schools were not
up to standards. In the end, he recommended that one
hundred twenty of the one hundred fifty five he reviewed
for the report should be closed. That recommendation was based
on his assessments that their standards were very poor and
that they were not keeping up scientifically and thus were
creating poorly educated doctors who lacked up to date knowledge
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in their field, which was something he saw as a
completely obvious danger to public health. Canadian schools, we should mention,
fared much better than their US counterparts. Overall, only one
school there made Flexner's list of closing recommendations. It was
not closed, though. They did have a little bit of
a review of their curriculum and their standards and changed
(19:24):
up a little. Many of the schools in the US
that he recommended be closed did close. Within a decade,
there were only half as many medical schools as there
had been when Flexner's report was published. Those that had
remained had reformed their standards, and their courses and their
lab work in clinical teaching had been significantly changed and
(19:44):
in most cases modernized. For all of the change that
was catalyzed by the report, Flexner became famous as an
educational reformer. We're gonna pause here before we dig into
the ramifications of Flexner's work for black medical schools specifically,
so here in the meantime are some of the sponsors
that keep stuff you missed in history class going. Before
(20:12):
we talk about the effects of the Flextioner Report on
the black population in the US and its medical schools,
we should give a brief sense of what was going
on in that space prior to nineteen. The first black
man in the US to receive a medical degree was
David J. Peck. He received a degree from Rush Medical
School in Chicago in eighteen forty seven. As a note,
(20:32):
he was not the first black doctor in the US
that's usually cited as formerly enslaved. James Durham, who was
born in seventeen sixty two and learned medicine through an
apprenticeship in the thirteen years after Pack's graduation, there were
a handful of other black med students who graduated with degrees.
In the US, nine medical schools had established that they
(20:55):
would admit black students by eighteen sixty, including the Medical
School of Heart of Harvard University, Bowden Medical School in Maine,
and the Medical School of the University of New York.
In the late eighteen sixties, the first medical school for
black students opened. That was Howard University Medical School in Washington,
d c. And it opened in eighteen sixty eight. Eight
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years later, Maharry Medical College opened in Nashville, Tennessee. From
eighteen seventy six to nineteen o four, another six black
medical schools opened, including Lettern Medical School, which became Shaw
University in Raleigh, North Carolina, New Orleans University Medical College,
Knoxville College Medical Department that became Knoxville Medical College, Chattanooga
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National Medical College, and University of West Tennessee College of
Physicians and Surgeons. The schools listed there are ones that
were open when Flexner compiled the report. There had been
others that had folded before the nineteen o eight research started.
That included Lincoln University in Oxford, Pennsylvania, which had opened
in eighteen seventy and closed four years later. Straight University
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Medical to Artment was established in New Orleans in eighteen
seventy three, but was disbanded in eighteen seventy four. Hannibal
Medical College of Memphis, Tennessee, had opened in eighteen eighty nine,
but closed in eighteen ninety six. Louisville States University Medical
Department ran from eighteen ninety nine to nineteen o three.
Chattanooga National Medical College closed in nineteen o four after
(22:22):
five years in operation. The Medical Society of the District
of Columbia was founded in eighteen seventeen. That society was
for whites only. The American Medical Association was founded in
eighteen forty seven, and though black doctors applied to become
members for years, they were denied entry. We're gonna come
back to the A M and just a bit. The
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Medico Turigical Society was founded as a black medical society
in eighteen eighty four because of the impossibility that black
doctors faced gaining admittance to those established groups. The National
Medical Association was founded in eighteen ninety five for black
doctors for the same reason. It was not until the
nineteen fifties that black doctors had gained admittance to medical
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societies in most states. In the midst of this clear
division and racism, the Flexner Report was released. Flexner had
often been lauded for his role as a reformer, and,
as we've discussed, reform did need to happen. He was
obviously blunt and often scathing in his critiques of individual schools,
and the schools for black men students were no different,
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and his report he wrote, quote, of the seven medical
schools for negroes in the United States, five or at
this moment in no position to make any contribution of value.
While he praised both Howard and Maharry is worth developing,
the rest were deemed basically useless. This assessment did not
take into account the fact that black medical schools charged
much lower tuition than white schools, had fewer endowments, and
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were operating on much narrower margins. In his assessment, he wrote, quote,
the negro needs good schools rather than many schools. He
went on to elaborate eight that it was important for
black doctors to be well educated. He understood that black
doctors would see to the health of the black population,
and since the black population was a part of the
(24:10):
larger whole, their care was important. But the language that
Flexner used throughout this section where he talked about all
of this is a very mixed bag. He simultaneously speaks
of the rights and contributions of black people, but also
asserts that it is best if black doctors take care
of their own people and offers the teaching of hygiene
as one of the most important duties of black doctors
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and nurses, rather than life saving skills, which is just
inherently racist. Every black medical college that Flexner called out
as subpar closed. The first four had shut their doors
by nineteen fourteen, a fifth closed in nineteen fifteen. The
last from the last list, the Medical Department of the
University of West Tennessee, lasted until Howard and Maherry remained
(24:58):
and they still do. The tr is Our Drew Medical
School in Los Angeles was the next predominantly black medical
school to open. That didn't happen until nineteen sixty six.
Listen to our episodes on Brown v Board Like that
seems late in the creation of a medical school um,
but that school was founded like specifically to respond to
(25:18):
to medical access needs within the black community. The next
was Morehouse School of Medicine in Atlanta in nineteen So
the narrowing of options for prospective black doctors left a
huge care gap for the black community. Many potential physicians
were excluded from educational opportunities due to location, which meant
that the care of black patients was often doled out
(25:40):
by white doctors, who, even in the best of circumstances,
met their duties with inherent racial bias. And as we
have discussed on the show before, there were definite racist
abuses of power in the medical system, and this has
had far reaching and ongoing consequences. A panel was assembled
by the American Medical Associate Institute for Ethics in two
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thousand five to examine the history of racism and the
medical profession. One of their findings was that the Carnegie
Foundations project for which they hired Flexner, that had been
sponsored by the a m A as well, although that
hadn't been disclosed at the time. Flexner's line of good
schools rather than many schools, had ensured that medicine stayed segregated,
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and that communities who needed doctors the most were just
left without them. Yeah, there are some question marks that
continue about whether or not someone associated with the A
m A was actually with him on some of those
school visits, and at some points in history he said
that that person was with him, and then later on
he was like no, no, no, no, no, like they
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met me there, like it it shifted. So we don't
really know if there was even more hands on direction
of that report in that regard or not. A lecture
on the now defunct Black med schools by Dr Earl H.
Harley of Washington, d C. Was published in the Journal
of the nation No Medical Association in September of two
thousand six, and in it, Dr Harley summarized how black
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medical schools, which have always been smaller with a higher
percentage of graduates going into medicine for underserved communities, have
continued to face obstacles in the century since Flexner's report,
writing quote, one of the greatest challenges of today's black
medical schools is economics. Black medical schools find it difficult
to compete with well funded majority universities with a long
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standing commitment to train African Americans, such as the University
of Michigan. The result maybe the siphoning of well qualified,
highly competitive African American students who choose quote rich schools
for pragmatic economic reasons. This places an extra burden on
today's black medical schools of appealing to a higher social
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calling as they seek to fulfill their historic missions. While
they search for greater endowments to become more attractive, they
must continue to position themselves as the training grounds for
those who will serve the underserved. So those brings up
a natural question. Did Flexner realize the disproportionate impact of
his report on black med students and doctors and patients?
(28:09):
He spoke at length about race throughout his life, But
what were his intentions with this report? And I mean,
apart from his attentions the effects that we just mentioned. Yeah,
but we don't know what his mindset was. Uh, And
there are different schools of thought on it. You can
talk to a lot of people and they will give
you completely different answers for whether or not they thought
that there um was racism in the mix, or if
(28:31):
Flexner really understood this. He did know that he was
limiting the scope of black medicine. He said so in
his report, although it is part of a rather idealist
passage that reads, quote, the upbuilding of Howard and Maherry
will profit the nation much more than the inadequate maintenance
of a larger number of schools. They are, of course
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unequal to the need and opportunity. But nothing will be
gained by satisfying the need, or of rising to the opportunities,
through the survival of feeble, ill equipped institutions, quite regardless
of the spirit which animates the promoters in Flexner wrote
a letter to the trustees of his Institute for Advanced
Studies and which he advocated against discrimination. Quote. It is
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fundamental in our purpose and our express desire that in
the appointments to the staff and faculty, as well as
in the admission of workers and students, no account shall
be taken directly or indirectly of race, religion, or sex.
We feel strongly that the spirit characteristic of America at
its noblest, above all, the pursuit of higher learning, cannot
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admit of any conditions as to personnel other than those
designated to promote the objects for which this institution is established,
and particularly with no regard whatever to accidents of race
creat or sex. It appears that Flexner's progressive ideas about equality,
particularly in relation to race, probably came from his childhood
in Louisville. One biographer who is very sympathetic to Flexner,
(29:59):
Thomas Neville Honor, made the case in his book about
Flexner that when Abraham was growing up in Louisville, Kentucky,
it was a time when, while there was certainly nothing
akin to equality, there were more services and opportunities for
the city's black community than in a lot of other places.
Uh there were a dozen schools for black students there
when Abraham was growing up, and professional training schools and teaching, medicine,
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and law were available to black residents. And the Flexner's,
who were not wealthy, lived in a neighborhood where they
had black neighbors. Abraham noted later in his life that
he and his siblings often played with the black children
in their neighborhood. This experience may have left Abraham Flexner
a little idealistic about the realities of life for the
black families that he knew and socialized with. To him,
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it seemed obvious that any of the kids he played
with could grow up to do the same kinds of
jobs that he and his siblings could do. But it
seems that he didn't really come to terms with the
fact that there were plenty of other people who didn't
see things this way. He acknowledged during his lifetime that
he didn't realize that the black students he had known
growing up were so deeply disadvantaged until later in his
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life when he was researching and analyzing educational institutions after
his retirement from the Institute. Both before and after World
War Two, Flexner was pretty outspoken against prejudice. He made
a radio broadcast in which he stated his disappointment that
democracy hadn't brought more equality to the relationship between races.
After the war, he spoke about how far behind England
(31:26):
the US was in terms of both religious and racial prejudice.
But his feelings about prejudice are complicated. I'll also say that, um,
that's an interesting note about England in the US in
terms of re I feel like Flexner always compared the
US to European countries he had visited, and he always
(31:48):
found the US lacking by comparison. But some of that
is definitely a rose colored glass of situation. Yeah, yeah,
I don't. I don't know when he made that statement. Um,
but something that is going to come up in an
episode we're gonna record shortly is like about racism uh
in England specifically. Anyway, back to the subject at hand, Uh,
(32:10):
His feelings about prejudice are complicated. Although he had been
raised by devout Jewish parents, Abraham and his siblings all
drifted away from the Jewish faith and they considered themselves
secular Jews. When he encountered anti semitism, he tended to
presume the person involved was ignorant instead of malicious, and
he just brushed it off and went on with his life.
But he was in a position to be able to
(32:32):
do that. Anti Semitism doesn't seem to have materially impacted
his career or his life. Yeah, this is definitely one
of those cases where I think he doesn't realize that
he was, you know, enjoying a certain degree of privilege
and being able to be like, oh, you don't like me, Okay,
I still have plenty of opportunities, which is not how
it works for everybody. The true depth of racism against
(32:55):
the black community was clearly a blind spot in his work,
and that left a lasting legacy on both black physicians
and patients that is still felt. He just thought that
medical schools and other institutions of higher learning should be
admitting students regardless of their sex, color, or religion. But
he didn't seem to recognize that there was a whole
world of obstacles that had to be addressed to get
(33:15):
to the point where students who weren't white or weren't
male could even be applying to medical school, let alone
get through the admission process. And in a way, it
struck me while I was researching this that his own
idealism put him in this situation not dissimilar to the
scientists that he once wrote about who accidentally advanced the
technologies of warfare. In his work for school reform, the
(33:38):
already disadvantaged black schools simply could not keep pace with
standards that required money and resources they simply didn't have,
and white schools were still not often admitting black medical students.
The debate over Flexner's intentions continues among medical historians, and
if you start digging, you'll find people who think of
him as everything from a benevolent but a realist. We've
(34:01):
talked about a lot of those on the show too
inherently racist, talked about a lot of those two um
and this this latter part is due to the discussion
of hygiene as a primary focus for black physicians. There
are examples of leaders from both Maharry and Howard using
similar language regarding the need for hygiene instruction as an
important part of the service of black doctors. They predate
(34:23):
Flexner's report by a couple of years, and this is
on its surface inherently racist. Those leaders who also said
that that was an important part of a black doctor's
training we're also white. But it also suggests that Flexner's
statements were echoes of the school stated missions, rather than
standalone judgments that he made. And there is also an
(34:44):
interesting possibility, as discussed in a eleven article in the
Journal of the History of Medicine and Allied Sciences by
Lynn E. Miller and Richard M. Weiss, that this language
was actually part of carving out a public health role
for the physicians from these schools in an f to
garner support for the schools across racial divides. In the
statements from Maherry and Howard in nineteen o seven and
(35:07):
nineteen o eight that we're talking about those sentiments of
hygiene being the highest need are followed by mentions of
how obvious it is thus that these institutions should be supported.
And there are some indicators that a number of medical schools,
black and white. We're already in an economic tail spin
before Flexner's report was released. Some of that was because
(35:28):
there were already efforts to try to meet guidelines that
had been issued by the a m A, and the
financial burdens of doing that just proved to be too
much to allow for sustainability. While the discussion of Flexner's
intentions and the real ramifications of his work continues, the
a m A, following the findings of their Ethics Council,
did issue a public apology in two thousand and eight,
(35:48):
quote for its past history of racial inequality toward African
American physicians, and shares its current effort to increase the
ranks of minority physicians and their participation in the a
m A. The organization also announced a number of programs
aimed at encouraging minorities to pursue careers in medicine. This
is one of those cases where we're still untangling all
(36:09):
the ten drills of all these influences on the medical
field that will probably continue for years to come. I
wanted to close with another quote from Flexner's Usefulness of
Useless Knowledge. I personally remain in a state of conflict
about the man and his work. Uh. It's like I
want to support an idealist who wants to make things better,
but not when that idealism blinds you so much that
(36:30):
you end up hurting people. Um. But when I came
across this passage while I was researching, it really hit
me in its pertinence to our world today. Uh. And
he wrote, quote the justified outcry of those who, through
no fault of their own, are deprived of opportunity and
a fair share of worldly goods, therefore diverts an increasing
number of students from the studies which their fathers pursued
(36:53):
to the equally important and no less urgent study of social, economic,
and governmental problems. I have no quarrel with this tendency.
The world in which we live is the only world
about which our senses can testify. Unless it has made
a better world, a fairer world, millions will continue to
go to their graves silent, saddened, and embittered. That is
(37:15):
the complicated Flexner report. Yeah, I think it's worth knowing that.
Like there's there's a question sometimes where it seems like
people are kind of asking was he racist? Or um,
was he operating from best intentions? And it can be
operating yet if he's operating from his best intentions, like
(37:38):
still racist though, Like it's impossible to grow up in
a position of privilege in a racist society that is
threaded all through with many layers of racist of racism
and like to not be racist, Like it is a
lifelong effort to undo all of those thinking patterns, no
matter how well intended you are. Yeah, I mean, it's
(38:01):
it's one of those things when you read his writing,
he so clearly believes that, like if we just shut
down all the bad black medical schools, these two good
ones are going to be so good that then we
can expand from there and everything will be great. And
it's like he's missing so much of the puzzle that
like again in an ideal world, sure, but like, um, yeah,
(38:26):
he's he's complicated. I have complicated feelings about him. Um,
do you have a listener mail? I do. It's much
less complicated. It's a very very lovely listener mail from
our listener, Crystal, who writes History of Science Topics is
my Jam, which I liked because it's fine too. She writes,
Dear Holly and Tracy, I'm writing to say I love
your podcast. I've always enjoyed learning about history, and you
(38:47):
make it easy to listen to. Over the past few months,
I've been catching up with you going through your catalog
of I'm a scientist working in a lab in Canada
doing research with insects, and I just love when you
do podcasts on science it's related topics. I particularly like
the mention of Thomas Say from the New Harmony episode,
as he was an entomologist and taxonomist, and I would
like to know more about the lives of these people
(39:09):
from the past. Uh. In my work, I've been able
to help digitize historical insects specimen records. This sounds so cool, uh,
And I'm always amazed and I find collection labels that
say the specimen was collected during World War One or
World War Two. What were these scientists doing during these
difficult times and why were they continuing their research and
not involved in particular wartime efforts. I also thoroughly enjoyed
(39:31):
learning about Chen Chung Woo, whom I had never heard
about before. She was a pioneer in physics and has
certainly inspired me as a woman. Scientists. Please share more
of these kinds of stories. Lastly, I just finished listening
to your episode on the discovery of helium. Again. I
just love hearing about topics like this. UM. I wanted
to read this in part because Uh it ties in
a little bit to uh Flexner's discussion of how in
(39:55):
that that seemingly useless knowledge becoming useful. He talks about
how sometimes science just step away from the realities of
current events to continue to do their work. But I
can't speak specifically to those specimen collectors that got those insects,
although again, that sounds super interesting. So thank you so much, Crystal.
I love that you work in in science and that
(40:17):
there's entomology happening under your hand. We appreciate it, and
we're grateful to be along with you on some of
that journey. If you would like to write to us,
you can do so at History Podcast at iHeart radio
dot com. You can also find us pretty much everywhere
on social media as Missed in History, and if you
would like to subscribe this super easy to do. You
can do that in the I heart Radio app, on
Apple podcasts, or wherever it is you listen. Stuff you
(40:45):
missed in History Class is a production of I heart Radio.
For more podcasts from i heart Radio, visit the i
heart Radio app, Apple Podcasts, or wherever you listen to
your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Holly Frying, and I'm Tracy P. Wilson. Uh, Tracy.
One of the topics that's come up a couple of
times for me in recent weeks as I've just been
doing my own reading related to racial injustice is the
(00:24):
Flexner Report. And this was a report that was issued
in the early twentieth century. It is often credited with
changing the medical field and shaping what medical education looks today.
I also found one article that said it's the most
overrated document in medical history, which made me laugh a
bit um. But there are also aspects of this document
that really need to be discussed in terms of how
(00:45):
they impacted the black community. So we're going to talk
about this one in three parts. First, we're going to
talk about Abraham Flexner, for whom the report is named
and who made the report. And then we're going to
talk about the general impact of the Flexner Report on medicine.
And finally we will talk about how this affected black
medical schools specifically. And it is a lot to unpack,
(01:05):
and I hope we managed to do it justice as
with anything related to any of these topics, a person's biography,
the history of any given field, and the history of
how things impact racial injustice. Like, there are always more
nuances than we could ever pack into an episode, but
we're hoping we hit all of the prominent and impertinent points. Yeah,
(01:25):
if you listen to the podcast Saw Bones, they did
an episode which I guess at this point will be
a few weeks ago that was about racism in medicine
and it it alludes to this without going into much
detail about it. So if you if you listen to
our show and that show, these are sort of they'll
complement one another. They do, they do. We didn't plan that,
(01:47):
it just happened. Uh So this starts with Abraham Flexner
and Abraham Flexner was born in Louisville, Kentucky, on November
eighteen sixty six. His father more It's Flexner and his
mother as their Abraham, were German Jewish immigrants. More It's
had a hat business and Esther worked as a seamstress.
(02:08):
The Flexner family was large. Abraham was their sixth child
and they ultimately had nine. Moret's and Esther were able
to build up their finances with The plan not that
they would live lavishly, but that every one of their
sons and there were seven of them, would attend college.
But that plan fell apart when the eighteen seventy three
panic hit and they lost their savings. But Abraham did
(02:31):
manage to go to college. He attended Johns Hopkins University,
and the funds came from his brother, Jacob. The span
and the ages of the Flexner children meant that Jacob
was already established by the time Abraham graduated from high school,
and the money he was making as a drug store
owner was put towards Abraham's tuition. Yeah, they definitely always
(02:52):
prioritized education is where they put their money. Abraham earned
his b a In eighteen eighty six, and his hope
had been and to go into a post graduate program,
but there was not enough money for that, and though
he did try to secure a fellowship and non materialized,
so he went home to Louisville to start his career.
For the next four years, Flexner worked as a high
(03:14):
school teacher, heading up the Latin and Greek classes at
Louisville High School. But during that time he was developing
another idea because he thought there was a better way
to structure education, and that idea manifested as an experimental school,
and Flexner founded that school in eighteen nine. That school
was simply called Mr. Flexner School, and it was incredibly progressive.
(03:35):
The structure probably seemed like no structure at all to
traditional educators. Flexner did away with the idea of a
set curriculum. Students did not have exams, and they did
not receive grades. The vision that Flexner had for this
school was custom tailored education to prepare students for higher learning,
and a lot of his students got into very good schools,
(03:56):
so this was a very successful model. The Flexner family
continued to value education and help one another in that regard.
One of the personal benefits for Abraham Flexner in creating
his school was that he could enroll his brother Simon
there and get him into JOHNS. Hopkins. He was also
able to pay for Simon's tuition. Abraham also helped his
(04:17):
sister Mary, he paid her way at Brent mar This
marks an expansion of the family's plan to not only
educate the men of the family, but also the women,
and education for women was something that Abraham supported throughout
his life. One of the former pupils in Flexner's preparatory school.
A young woman named Anne Crawford also became an important
(04:37):
part of Abraham's life after graduating and had become a teacher.
She had attended Massar in which he finished those studies.
She started working there at the school, and she also
had started to pursue a career as a playwright. Abraham
and Anne fell in love and they were married in
and they eventually had two daughters, Jean and Eleanor. In
nineteen o four, and adapted the novel Mrs Wiggs of
(05:00):
the Cabbage Patch, which is a comedic story about an
impoverished Southern family, into a Broadway play. Mrs Wiggs ran
from September three, nineteen o four, through January nineteen o
five at the Savoy Theater, and it was a success.
The income from Ant's work on the show made it
possible for Abraham to enroll at Harvard to get his
master's degree in psychology. He closed his school to do that.
(05:24):
He also spent a year in Germany as part of
his studies, again bankrolled through his wife's success in the theater.
That time spent in Germany made Flexner deeply aware of
what he saw as the failings of the education system
back home, and as a result, in nineteen o eight,
he researched and wrote an assessment of higher education in
the United States titled the American College a Criticism. Based
(05:48):
on his work examining colleges and identifying what he saw
as the problems at the single school level as well
as systematically, flexnerra was commissioned by the Carnegie Foundation for
an new project. He was asked by the president of
the Carnegie Foundation for the Advancement of Teaching, that was
Henry Smith Pritchett, to apply that same critical and analytical
(06:10):
eye to the medical institutions, specifically in the United States
and Canada. There were a hundred and fifty five medical
schools in his survey. Yeah, he took two years to
basically travel around and visit all these schools and do
his assessment, and then in nt Flexner completed his report
which was titled Medical Education in the United States and Canada.
(06:32):
And when this report came out, it had a massive
impact on medical education in North America. A lot of
the schools that Flexner had found lacking closed as a
consequence of its publication. Others were completely overhauled and essentially
rebuilt from the ground up, and we're going to talk
more about all of that in just a moment. Following
the medical school report, Flexner produced a report at the
(06:54):
behest of the Rockefeller Foundation examining the sex work field
in Europe and how it was re elated. It was
the first of many varied reports that Flexner would compile
for the Foundation. But though he had moved on to
other projects like that, Flexner did not just drop his
medical report and then move on with his life. He
actually dedicated himself to improving medical education, specifically, in nineteen thirteen,
(07:19):
following his report on European sex work, Flexner became the
secretary to the Rockefeller Foundation's General Education Board. During this time,
in his role, he worked on a number of other
research and reporting projects, as we mentioned, but he also
made sure that money from private donors was allocated to
medical education and improving some of the problems he had
(07:40):
discovered while working on his nineteen ten report. In ninety one,
Abraham Flexner wrote a memo for the Rockefeller Foundation's Board
which was titled The Usefulness of Useless Knowledge, and this
memo evolved and it became a lecture, and then, eighteen
years after he initially wrote it, it was published in
Harper's Magazine, And that piece of writing opens with the
(08:01):
following paragraph quote, Is it not a curious fact that,
in a world steeped in irrational hatreds which threatened civilization itself,
men and women, old and young, detached themselves wholly or
partly from the angry current of daily life, to devote
themselves to the cultivation of beauty, to the extension of knowledge,
(08:22):
to the cure of disease, to the amelioration of suffering,
just as though fanatics were not simultaneously engaged in spreading pain, ugliness,
and suffering. The world has always been a sorry and
confused sort of place. Yet poets and artists and scientists
have ignored the factors that would, if attended, to paralyze them.
(08:43):
From a practical point of view, intellectual and spiritual life is,
on the surface, a useless form of activity in which
men indulge because they procure for themselves greater satisfactions than
are otherwise obtainable. In this paper, I shall concern myself
with the question of the extent to which the pursuit
of these useless satisfactions proves unexpectedly the source from which
(09:05):
undreamed of utility is derived. One of the things that
Flexner touches on in this writing is the unintentional outcomes
of pursuits that were of pure intent. He specifically mentions
how the advancement of the cruelty of warfare was fueled
by scientists who were often working they thought for the
betterment of mankind. As the nineteen twenties were on, Abraham
(09:28):
Flexner found himself at odds with other members of the
education board at the Rockefeller Foundation, and this led to
him ultimately being pushed out of the organization in ninety eight.
In nine nine, Abraham Flexner was approached by philanthropist siblings
Lewis and Caroline Bamburger. The Bamburgers thought they could use
their wealth to establish a new medical school in Newark,
(09:51):
New Jersey, and they wanted Flexner as an advisor on
the project. But Flexner pointed out that Newark had neither
a teaching hospital nor a top notch university, both of
which were vital to the success of a medical school,
and Abraham Flexner was really thinking of a different sort
of project, and he was able to convince the Bamburgers
that they should instead invest in his idea, and they
(10:13):
did with a gift of five million dollars. Flexner envisioned
what he would later call an educational utopia that offered
the greatest minds a place where they could be driven
entirely by their curiosity, and so in nineteen thirty Flexner
founded the Institute for Advanced Study in Princeton, New Jersey,
and served as director there until nineteen thirty nine. It's
(10:35):
missions stated quote, the Institute is pledged to assemble a
group of scientists and scholars who, with their pupils and assistants,
may devote themselves to the task of pushing beyond the
present limits of human knowledge, and to training those who
may carry on. In this sense, Flexner was able to
attract some of the biggest names to his institute, including
Albert Einstein, who joined in nineteen thirty three. In the
(10:59):
years since it's founding, the Institute has had as members
or as faculty thirty four Nobel Laureates, forty two Fields Medalists,
and eighteen Abel Prize Laureates. In addition to Einstein, notable
names on that list include Robert Oppenheimer and previous podcast
subject John von Neumann. We're going to cover the end
of Flexner's life and the impact of his work on
(11:20):
medical education, but we're due for a quick break to
have a word from our sponsors. The same year that
he opened his institute, Abraham also published another book about education.
This time it was a comparative review of how schools
(11:41):
ran in different countries, titled Universities American, English, German. Flexner
retired as director at the institute in nineteen thirty nine
after an internal conflict in which the school was accused
of allowing an anti Semitic climate at Princeton, a school
that they routinely worked with. They were allowing that climate
to hinder the work of a lot of the professors.
(12:04):
As tensions among the scholars and leadership war on. Flexner
retired in the autumn of ninety nine. Although he was
in his seventies, He stayed very busy after leaving the institute,
consulting on various projects and writing several books, including his autobiography.
During and after World War Two, several of Abraham's siblings
died by the end of the nineteen forties. Only Abraham
(12:27):
and his sister Gertrude were still living out of the
nine Flexner siblings. At the same time, his wife, Anne
had gradually developed vascular dementia in nine and had declined
so seriously that she was taken to a Rhode Island sanitarium.
Their two daughters frequently visited her, and they updated their father,
but Abraham never saw Anne again. He had not coped
(12:49):
with her illness well and could not bear to have
the person that he had been so close to no
longer recognize him. He later told friends that he had
actually had a breakdown during this time. As he recovered
from this significant change in his life, Flexner moved to
a hotel near Central Park and enrolled in classes at Columbia.
He opted for classes in literature and history. In nineteen
(13:11):
fifty one, the New York Times read an article about
the eighty five year old Flexner educational reformer taking classes
alongside co Ed's, a quarter his age, and died shortly
before Abraham's ninetieth birthday, which once again sent him into
a dark period, and as he was slowly returning to
his old self, his daughter Jeane convinced him to leave
New York and moved to Falls Church, Virginia, which is
(13:33):
where she lived so that he could be near her,
and he spent two years there and doing a very
active social life and visiting the museums of nearby Washington,
d c. Regularly before his death on September twenty one,
nineteen fifty nine. So moving on to his report about
medical schools. As we mentioned, Flexner covered a hundred and
fifty five schools in his nineteen ten report, and in
(13:55):
researching that report, he had visited each school and written
detailed and comprehensive notes about their entrance requirements, faculty funding, laboratories,
and connections with affiliated hospitals. In the five decades before
his research, massive advances in science and medicine had been made,
but because there was no comprehensive guidance for how medical
(14:16):
schools operated, a lot of them were still teaching out
of date information, basically telling future doctors stuff that wasn't
believed to be true anymore. This was in large part
because the faculty at many medical schools consisted largely of
practicing physicians who were teaching exactly as they had been
taught without updating that information with the changing times. Bacteriology,
(14:40):
diagnostic developments, and surgical techniques were all rapidly changing fields,
and if a school wasn't keeping up the doctors they trained,
or in danger of offering their patients poor or outdated
care at best and endangering their lives at worst. To
compound that problem, there were a lot of new medical
schools opening with totally read standards for entry. When Flexner
(15:03):
published to study, seventy four percent of a medical schools
that were open required only a high school education for admission.
Some were willing to accept high school equivalency certificates, which
meant that there was really no clear standard. Only a
fifth of the schools required two or more years of
college prior to entry. Many were essentially profit driven businesses.
(15:26):
Abraham Flexner was also very frank in his report about
how little the public really knew about the workings of
any given medical school. He wrote in the introduction quote,
educational institutions, particularly those which are connected with a college
or a university, are peculiarly sensitive to outside criticism, and
particularly to any statement of the circumstances of their own
(15:48):
conduct or equipment which seems to them unfavorable in comparison
with that of other institutions. As a rule, the only
knowledge which the public has concerning an institution of learning
is derived from the statements given out by the institution itself,
information which, even under the best circumstances, is colored by
local hopes, ambitions, and points of view. Flexner felt that
(16:12):
this work was vital and important to be doing, writing
that the information in it was of importance not just
to medical practitioners, but to quote every citizen of the
United States and Canada. Abraham Flexner, building on standards that
were already in place in Germany, established standards of evaluation
for the medical schools and his study and then judged
(16:32):
each one against those criteria. And we should note that
he was not the first person to do this. In
the United States, the Association of American Medical Colleges, founded
in eighteen seventy six and consisting of twenty two member schools,
had agreed on curriculum standards to provide uniformity in medical
education that had happened after an assessment of the state
(16:52):
of medical education. The a a m C continued to
grow and reevaluate in the years between its founding and
flex Nurse Report. The American Medical Association had similarly started
issuing reports on the status of medical education as early
as eight and some of the criteria they used were
present in Flexner's evaluation system as well, but neither of
(17:15):
these had oversight over all medical schools. It was an
opt in on a set of standards. All of Flexner's
work was aimed at determining, in his opinion, whether a
school was able to effectively teach its students modern medicine.
The model that he drew up for what this looked
like included admittance requirements of college level biology, chemistry, and
(17:37):
physics courses, a curriculum with both lecture and lab teaching
of anatomy, pathology, bacteriology, and pharmacology, among other courses, access
to teaching hospitals for hands on experience, salaried faculty who
were exclusively working in teaching and research, not practicing doctors
who just taught on the side. Flexner laid out his
(18:00):
finding state by state and school by school. He was
detailed calling out if he had found dirty labs or
lacks standards. He criticized the way the days were scheduled
at schools and how exhausted students were often sitting through
hours of dull lectures by part time faculty. Because he
was an outsider, an education reformer rather than a member
(18:20):
of the medical community. His assessment was without preconception and
it was brutally honest, offering the general public a startling
look at the way people who cared for their health
were being educated. Flexner advocated for state licensing boards to
take a more assertive role in modernizing medicine by refusing
to license graduates from schools that were not up to standards,
(18:42):
and he believed that a lot of schools were not
up to standards. In the end, he recommended that one
hundred twenty of the one hundred fifty five he reviewed
for the report should be closed. That recommendation was based
on his assessments that their standards were very poor and
that they were not keeping up scientifically and thus were
creating poorly educated doctors who lacked up to date knowledge
(19:03):
in their field, which was something he saw as a
completely obvious danger to public health. Canadian schools, we should mention,
fared much better than their US counterparts. Overall, only one
school there made Flexner's list of closing recommendations. It was
not closed, though. They did have a little bit of
a review of their curriculum and their standards and changed
(19:24):
up a little. Many of the schools in the US
that he recommended be closed did close. Within a decade,
there were only half as many medical schools as there
had been when Flexner's report was published. Those that had
remained had reformed their standards, and their courses and their
lab work in clinical teaching had been significantly changed and
(19:44):
in most cases modernized. For all of the change that
was catalyzed by the report, Flexner became famous as an
educational reformer. We're gonna pause here before we dig into
the ramifications of Flexner's work for black medical schools specifically,
so here in the meantime are some of the sponsors
that keep stuff you missed in history class going. Before
(20:12):
we talk about the effects of the Flextioner Report on
the black population in the US and its medical schools,
we should give a brief sense of what was going
on in that space prior to nineteen. The first black
man in the US to receive a medical degree was
David J. Peck. He received a degree from Rush Medical
School in Chicago in eighteen forty seven. As a note,
(20:32):
he was not the first black doctor in the US
that's usually cited as formerly enslaved. James Durham, who was
born in seventeen sixty two and learned medicine through an
apprenticeship in the thirteen years after Pack's graduation, there were
a handful of other black med students who graduated with degrees.
In the US, nine medical schools had established that they
(20:55):
would admit black students by eighteen sixty, including the Medical
School of Heart of Harvard University, Bowden Medical School in Maine,
and the Medical School of the University of New York.
In the late eighteen sixties, the first medical school for
black students opened. That was Howard University Medical School in Washington,
d c. And it opened in eighteen sixty eight. Eight
(21:16):
years later, Maharry Medical College opened in Nashville, Tennessee. From
eighteen seventy six to nineteen o four, another six black
medical schools opened, including Lettern Medical School, which became Shaw
University in Raleigh, North Carolina, New Orleans University Medical College,
Knoxville College Medical Department that became Knoxville Medical College, Chattanooga
(21:37):
National Medical College, and University of West Tennessee College of
Physicians and Surgeons. The schools listed there are ones that
were open when Flexner compiled the report. There had been
others that had folded before the nineteen o eight research started.
That included Lincoln University in Oxford, Pennsylvania, which had opened
in eighteen seventy and closed four years later. Straight University
(21:59):
Medical to Artment was established in New Orleans in eighteen
seventy three, but was disbanded in eighteen seventy four. Hannibal
Medical College of Memphis, Tennessee, had opened in eighteen eighty nine,
but closed in eighteen ninety six. Louisville States University Medical
Department ran from eighteen ninety nine to nineteen o three.
Chattanooga National Medical College closed in nineteen o four after
(22:22):
five years in operation. The Medical Society of the District
of Columbia was founded in eighteen seventeen. That society was
for whites only. The American Medical Association was founded in
eighteen forty seven, and though black doctors applied to become
members for years, they were denied entry. We're gonna come
back to the A M and just a bit. The
(22:42):
Medico Turigical Society was founded as a black medical society
in eighteen eighty four because of the impossibility that black
doctors faced gaining admittance to those established groups. The National
Medical Association was founded in eighteen ninety five for black
doctors for the same reason. It was not until the
nineteen fifties that black doctors had gained admittance to medical
(23:04):
societies in most states. In the midst of this clear
division and racism, the Flexner Report was released. Flexner had
often been lauded for his role as a reformer, and,
as we've discussed, reform did need to happen. He was
obviously blunt and often scathing in his critiques of individual schools,
and the schools for black men students were no different,
(23:26):
and his report he wrote, quote, of the seven medical
schools for negroes in the United States, five or at
this moment in no position to make any contribution of value.
While he praised both Howard and Maharry is worth developing,
the rest were deemed basically useless. This assessment did not
take into account the fact that black medical schools charged
much lower tuition than white schools, had fewer endowments, and
(23:50):
were operating on much narrower margins. In his assessment, he wrote, quote,
the negro needs good schools rather than many schools. He
went on to elaborate eight that it was important for
black doctors to be well educated. He understood that black
doctors would see to the health of the black population,
and since the black population was a part of the
(24:10):
larger whole, their care was important. But the language that
Flexner used throughout this section where he talked about all
of this is a very mixed bag. He simultaneously speaks
of the rights and contributions of black people, but also
asserts that it is best if black doctors take care
of their own people and offers the teaching of hygiene
as one of the most important duties of black doctors
(24:33):
and nurses, rather than life saving skills, which is just
inherently racist. Every black medical college that Flexner called out
as subpar closed. The first four had shut their doors
by nineteen fourteen, a fifth closed in nineteen fifteen. The
last from the last list, the Medical Department of the
University of West Tennessee, lasted until Howard and Maherry remained
(24:58):
and they still do. The tr is Our Drew Medical
School in Los Angeles was the next predominantly black medical
school to open. That didn't happen until nineteen sixty six.
Listen to our episodes on Brown v Board Like that
seems late in the creation of a medical school um,
but that school was founded like specifically to respond to
(25:18):
to medical access needs within the black community. The next
was Morehouse School of Medicine in Atlanta in nineteen So
the narrowing of options for prospective black doctors left a
huge care gap for the black community. Many potential physicians
were excluded from educational opportunities due to location, which meant
that the care of black patients was often doled out
(25:40):
by white doctors, who, even in the best of circumstances,
met their duties with inherent racial bias. And as we
have discussed on the show before, there were definite racist
abuses of power in the medical system, and this has
had far reaching and ongoing consequences. A panel was assembled
by the American Medical Associate Institute for Ethics in two
(26:01):
thousand five to examine the history of racism and the
medical profession. One of their findings was that the Carnegie
Foundations project for which they hired Flexner, that had been
sponsored by the a m A as well, although that
hadn't been disclosed at the time. Flexner's line of good
schools rather than many schools, had ensured that medicine stayed segregated,
(26:24):
and that communities who needed doctors the most were just
left without them. Yeah, there are some question marks that
continue about whether or not someone associated with the A
m A was actually with him on some of those
school visits, and at some points in history he said
that that person was with him, and then later on
he was like no, no, no, no, no, like they
(26:44):
met me there, like it it shifted. So we don't
really know if there was even more hands on direction
of that report in that regard or not. A lecture
on the now defunct Black med schools by Dr Earl H.
Harley of Washington, d C. Was published in the Journal
of the nation No Medical Association in September of two
thousand six, and in it, Dr Harley summarized how black
(27:05):
medical schools, which have always been smaller with a higher
percentage of graduates going into medicine for underserved communities, have
continued to face obstacles in the century since Flexner's report,
writing quote, one of the greatest challenges of today's black
medical schools is economics. Black medical schools find it difficult
to compete with well funded majority universities with a long
(27:26):
standing commitment to train African Americans, such as the University
of Michigan. The result maybe the siphoning of well qualified,
highly competitive African American students who choose quote rich schools
for pragmatic economic reasons. This places an extra burden on
today's black medical schools of appealing to a higher social
(27:46):
calling as they seek to fulfill their historic missions. While
they search for greater endowments to become more attractive, they
must continue to position themselves as the training grounds for
those who will serve the underserved. So those brings up
a natural question. Did Flexner realize the disproportionate impact of
his report on black med students and doctors and patients?
(28:09):
He spoke at length about race throughout his life, But
what were his intentions with this report? And I mean,
apart from his attentions the effects that we just mentioned. Yeah,
but we don't know what his mindset was. Uh, And
there are different schools of thought on it. You can
talk to a lot of people and they will give
you completely different answers for whether or not they thought
that there um was racism in the mix, or if
(28:31):
Flexner really understood this. He did know that he was
limiting the scope of black medicine. He said so in
his report, although it is part of a rather idealist
passage that reads, quote, the upbuilding of Howard and Maherry
will profit the nation much more than the inadequate maintenance
of a larger number of schools. They are, of course
(28:51):
unequal to the need and opportunity. But nothing will be
gained by satisfying the need, or of rising to the opportunities,
through the survival of feeble, ill equipped institutions, quite regardless
of the spirit which animates the promoters in Flexner wrote
a letter to the trustees of his Institute for Advanced
Studies and which he advocated against discrimination. Quote. It is
(29:14):
fundamental in our purpose and our express desire that in
the appointments to the staff and faculty, as well as
in the admission of workers and students, no account shall
be taken directly or indirectly of race, religion, or sex.
We feel strongly that the spirit characteristic of America at
its noblest, above all, the pursuit of higher learning, cannot
(29:35):
admit of any conditions as to personnel other than those
designated to promote the objects for which this institution is established,
and particularly with no regard whatever to accidents of race
creat or sex. It appears that Flexner's progressive ideas about equality,
particularly in relation to race, probably came from his childhood
in Louisville. One biographer who is very sympathetic to Flexner,
(29:59):
Thomas Neville Honor, made the case in his book about
Flexner that when Abraham was growing up in Louisville, Kentucky,
it was a time when, while there was certainly nothing
akin to equality, there were more services and opportunities for
the city's black community than in a lot of other places.
Uh there were a dozen schools for black students there
when Abraham was growing up, and professional training schools and teaching, medicine,
(30:22):
and law were available to black residents. And the Flexner's,
who were not wealthy, lived in a neighborhood where they
had black neighbors. Abraham noted later in his life that
he and his siblings often played with the black children
in their neighborhood. This experience may have left Abraham Flexner
a little idealistic about the realities of life for the
black families that he knew and socialized with. To him,
(30:43):
it seemed obvious that any of the kids he played
with could grow up to do the same kinds of
jobs that he and his siblings could do. But it
seems that he didn't really come to terms with the
fact that there were plenty of other people who didn't
see things this way. He acknowledged during his lifetime that
he didn't realize that the black students he had known
growing up were so deeply disadvantaged until later in his
(31:04):
life when he was researching and analyzing educational institutions after
his retirement from the Institute. Both before and after World
War Two, Flexner was pretty outspoken against prejudice. He made
a radio broadcast in which he stated his disappointment that
democracy hadn't brought more equality to the relationship between races.
After the war, he spoke about how far behind England
(31:26):
the US was in terms of both religious and racial prejudice.
But his feelings about prejudice are complicated. I'll also say that, um,
that's an interesting note about England in the US in
terms of re I feel like Flexner always compared the
US to European countries he had visited, and he always
(31:48):
found the US lacking by comparison. But some of that
is definitely a rose colored glass of situation. Yeah, yeah,
I don't. I don't know when he made that statement. Um,
but something that is going to come up in an
episode we're gonna record shortly is like about racism uh
in England specifically. Anyway, back to the subject at hand, Uh,
(32:10):
His feelings about prejudice are complicated. Although he had been
raised by devout Jewish parents, Abraham and his siblings all
drifted away from the Jewish faith and they considered themselves
secular Jews. When he encountered anti semitism, he tended to
presume the person involved was ignorant instead of malicious, and
he just brushed it off and went on with his life.
But he was in a position to be able to
(32:32):
do that. Anti Semitism doesn't seem to have materially impacted
his career or his life. Yeah, this is definitely one
of those cases where I think he doesn't realize that
he was, you know, enjoying a certain degree of privilege
and being able to be like, oh, you don't like me, Okay,
I still have plenty of opportunities, which is not how
it works for everybody. The true depth of racism against
(32:55):
the black community was clearly a blind spot in his work,
and that left a lasting legacy on both black physicians
and patients that is still felt. He just thought that
medical schools and other institutions of higher learning should be
admitting students regardless of their sex, color, or religion. But
he didn't seem to recognize that there was a whole
world of obstacles that had to be addressed to get
(33:15):
to the point where students who weren't white or weren't
male could even be applying to medical school, let alone
get through the admission process. And in a way, it
struck me while I was researching this that his own
idealism put him in this situation not dissimilar to the
scientists that he once wrote about who accidentally advanced the
technologies of warfare. In his work for school reform, the
(33:38):
already disadvantaged black schools simply could not keep pace with
standards that required money and resources they simply didn't have,
and white schools were still not often admitting black medical students.
The debate over Flexner's intentions continues among medical historians, and
if you start digging, you'll find people who think of
him as everything from a benevolent but a realist. We've
(34:01):
talked about a lot of those on the show too
inherently racist, talked about a lot of those two um
and this this latter part is due to the discussion
of hygiene as a primary focus for black physicians. There
are examples of leaders from both Maharry and Howard using
similar language regarding the need for hygiene instruction as an
important part of the service of black doctors. They predate
(34:23):
Flexner's report by a couple of years, and this is
on its surface inherently racist. Those leaders who also said
that that was an important part of a black doctor's
training we're also white. But it also suggests that Flexner's
statements were echoes of the school stated missions, rather than
standalone judgments that he made. And there is also an
(34:44):
interesting possibility, as discussed in a eleven article in the
Journal of the History of Medicine and Allied Sciences by
Lynn E. Miller and Richard M. Weiss, that this language
was actually part of carving out a public health role
for the physicians from these schools in an f to
garner support for the schools across racial divides. In the
statements from Maherry and Howard in nineteen o seven and
(35:07):
nineteen o eight that we're talking about those sentiments of
hygiene being the highest need are followed by mentions of
how obvious it is thus that these institutions should be supported.
And there are some indicators that a number of medical schools,
black and white. We're already in an economic tail spin
before Flexner's report was released. Some of that was because
(35:28):
there were already efforts to try to meet guidelines that
had been issued by the a m A, and the
financial burdens of doing that just proved to be too
much to allow for sustainability. While the discussion of Flexner's
intentions and the real ramifications of his work continues, the
a m A, following the findings of their Ethics Council,
did issue a public apology in two thousand and eight,
(35:48):
quote for its past history of racial inequality toward African
American physicians, and shares its current effort to increase the
ranks of minority physicians and their participation in the a
m A. The organization also announced a number of programs
aimed at encouraging minorities to pursue careers in medicine. This
is one of those cases where we're still untangling all
(36:09):
the ten drills of all these influences on the medical
field that will probably continue for years to come. I
wanted to close with another quote from Flexner's Usefulness of
Useless Knowledge. I personally remain in a state of conflict
about the man and his work. Uh. It's like I
want to support an idealist who wants to make things better,
but not when that idealism blinds you so much that
(36:30):
you end up hurting people. Um. But when I came
across this passage while I was researching, it really hit
me in its pertinence to our world today. Uh. And
he wrote, quote the justified outcry of those who, through
no fault of their own, are deprived of opportunity and
a fair share of worldly goods, therefore diverts an increasing
number of students from the studies which their fathers pursued
(36:53):
to the equally important and no less urgent study of social, economic,
and governmental problems. I have no quarrel with this tendency.
The world in which we live is the only world
about which our senses can testify. Unless it has made
a better world, a fairer world, millions will continue to
go to their graves silent, saddened, and embittered. That is
(37:15):
the complicated Flexner report. Yeah, I think it's worth knowing that.
Like there's there's a question sometimes where it seems like
people are kind of asking was he racist? Or um,
was he operating from best intentions? And it can be
operating yet if he's operating from his best intentions, like
(37:38):
still racist though, Like it's impossible to grow up in
a position of privilege in a racist society that is
threaded all through with many layers of racist of racism
and like to not be racist, Like it is a
lifelong effort to undo all of those thinking patterns, no
matter how well intended you are. Yeah, I mean, it's
(38:01):
it's one of those things when you read his writing,
he so clearly believes that, like if we just shut
down all the bad black medical schools, these two good
ones are going to be so good that then we
can expand from there and everything will be great. And
it's like he's missing so much of the puzzle that
like again in an ideal world, sure, but like, um, yeah,
(38:26):
he's he's complicated. I have complicated feelings about him. Um,
do you have a listener mail? I do. It's much
less complicated. It's a very very lovely listener mail from
our listener, Crystal, who writes History of Science Topics is
my Jam, which I liked because it's fine too. She writes,
Dear Holly and Tracy, I'm writing to say I love
your podcast. I've always enjoyed learning about history, and you
(38:47):
make it easy to listen to. Over the past few months,
I've been catching up with you going through your catalog
of I'm a scientist working in a lab in Canada
doing research with insects, and I just love when you
do podcasts on science it's related topics. I particularly like
the mention of Thomas Say from the New Harmony episode,
as he was an entomologist and taxonomist, and I would
like to know more about the lives of these people
(39:09):
from the past. Uh. In my work, I've been able
to help digitize historical insects specimen records. This sounds so cool, uh,
And I'm always amazed and I find collection labels that
say the specimen was collected during World War One or
World War Two. What were these scientists doing during these
difficult times and why were they continuing their research and
not involved in particular wartime efforts. I also thoroughly enjoyed
(39:31):
learning about Chen Chung Woo, whom I had never heard
about before. She was a pioneer in physics and has
certainly inspired me as a woman. Scientists. Please share more
of these kinds of stories. Lastly, I just finished listening
to your episode on the discovery of helium. Again. I
just love hearing about topics like this. UM. I wanted
to read this in part because Uh it ties in
a little bit to uh Flexner's discussion of how in
(39:55):
that that seemingly useless knowledge becoming useful. He talks about
how sometimes science just step away from the realities of
current events to continue to do their work. But I
can't speak specifically to those specimen collectors that got those insects,
although again, that sounds super interesting. So thank you so much, Crystal.
I love that you work in in science and that
(40:17):
there's entomology happening under your hand. We appreciate it, and
we're grateful to be along with you on some of
that journey. If you would like to write to us,
you can do so at History Podcast at iHeart radio
dot com. You can also find us pretty much everywhere
on social media as Missed in History, and if you
would like to subscribe this super easy to do. You
can do that in the I heart Radio app, on
Apple podcasts, or wherever it is you listen. Stuff you
(40:45):
missed in History Class is a production of I heart Radio.
For more podcasts from i heart Radio, visit the i
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Stuff You Missed in History Class News
Hosts And Creators
Holly Frey
Tracy Wilson
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